Laparoscopic cholecystectomy: from gimmick to gold standard

Laparoscopic cholecystectomy was first performed in 1987, and within 2 years had become widespread. Its rapid growth was due in part to a perceived reduction in postoperative morbidity and shorter convalescence than with open cholecystectomy. Although these perceptions were shared both by surgeons and the lay public, no controlled study has documented them conclusively, but now, because of its popularity, it is unlikely that such a study will ever be undertaken. Nevertheless, a wealth of information has been accumulated on open cholecystectomy, and a large body of data is being generated regarding laparoscopic cholecystectomy. We examine selected reports of both laparoscopic and open cholecystectomy in terms of incidence and outcome. Our review supports the notion that laparoscopic cholecystectomy is safe and effective, has an acceptable complication rate, and a considerably shorter convalescence. Thus, laparoscopic cholecystectomy is now the treatment of choice for symptomatic cholelithiasis, and is becoming the new gold standard against which other procedures should be judged.